With Comparable Outcomes, Should Early-Stage Lung Cancer Be a Contraindication to Lung Transplant?

• Published in: The Annals of thoracic surgery Vol. 118; no. 1; pp. 261 - 267
• Main Authors: Spies, Connor S., Ochoa, Timothy N., Pontula, Arya, Harris, Chelsea S., Snyder, Laurie D., Pavlisko, Elizabeth N., Hartwig, Matthew G.
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Inc 01.07.2024
• Subjects: Adult; Aged; Carcinoma, Non-Small-Cell Lung - complications; Carcinoma, Non-Small-Cell Lung - mortality; Carcinoma, Non-Small-Cell Lung - pathology; Carcinoma, Non-Small-Cell Lung - surgery; Contraindications, Procedure; Female; Humans; Lung Neoplasms - mortality; Lung Neoplasms - pathology; Lung Neoplasms - surgery; Lung Transplantation; Male; Middle Aged; Neoplasm Staging; Retrospective Studies; Survival Rate - trends; ILD; CT; LTx; KM; SOLT; NSCLC; BOLT; ISHLT; PET; COPD; LAS
• ISSN: 0003-4975; 1552-6259; 1552-6259
• DOI: 10.1016/j.athoracsur.2023.09.002

Active primary lung malignancy remains a strong contraindication to lung transplantation (LTx). However, outcomes are unclear for patients with early-stage non-small cell lung cancer (NSCLC) who undergo LTx. We hypothesize that patients with early-stage NSCLC incidentally discovered in the explanted lungs have survival comparable to LTx recipients without incidental cancer identified. We performed a single-center retrospective analysis of all LTx recipients from May 2007 to September 2021 with incidental cancer identified in the explanted lungs by pathologist report. Survival statistics were estimated using Kaplan-Meier analysis. Of the 1586 LTx performed, 23 patients (1.5%) were found to have incidental lung cancer in the explanted lungs. The most common indications for LTx were interstitial lung disease (n = 13) and chronic obstructive pulmonary disease (n = 7), and the most common histologic diagnosis was adenocarcinoma (n = 14). In the cohort with stage I disease (n = 9), the 1- and 5-year unadjusted Kaplan-Meier survival rates were 88.9% and 51.9%, respectively. The 1- and 5-year survival rates for transplant recipients without incidental cancer findings at LTx during this period were 86.7% and 59.4%, respectively, and did not differ significantly between the 2 strata (P = .96). Survival rates at 1 and 5 years were comparable between LTx recipients with incidentally noted pathologic stage I NSCLC and contemporary recipients without cancer. All cancer-related deaths occurred in recipients with incidentally noted advanced NSCLC. These results suggest that patients with pathologic stage I lung cancer at the time of transplant have outcomes comparable to those without cancer findings at the time of transplant. [Display omitted]